Provider Demographics
NPI:1043781149
Name:PURE SERENITY MASSAGE LLC
Entity Type:Organization
Organization Name:PURE SERENITY MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CEJMER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, BCTMB
Authorized Official - Phone:586-914-4201
Mailing Address - Street 1:PO BOX 230576
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48023-0576
Mailing Address - Country:US
Mailing Address - Phone:586-914-4201
Mailing Address - Fax:
Practice Address - Street 1:58540 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3592
Practice Address - Country:US
Practice Address - Phone:586-914-4201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty